RECEIVED · extract for weight control and-6 of respondent's use of thyroid reduction for...

MARTINESupervisor

RECEIVED

Westbury, N.Y. 11590

GUSTAVE

Rettan, Esq.229 Post Avenue, P.O. Box 125

1_cc: Jeffrey

]RR&C?XTIFIED MAIL-

DJIQGM~erEnclosures

Director of Investigations

aut.omatically.Very truly yours,

DANIEL J. KELLEHER

t!re effective date of the Order and the penalty; but said application is not grantedof which is attached. apply for restoration of your license after one year has elapsed from

and registration to this Department.

You may, pursuant to Rule 24.7 (b) of the Rules of the Board of Regents, a copy

time requirement of delivering your licenseo,f this letter even if you Sail to meet the :?at, dzte of this letter, Your penalty goes into effect five (5) days after thedays after the

e and registration to this Department within ten(10)

kensmus? deliver your the Order in your case is a revocation or a surrender of

your license, you

i 3219

Dear Dr. Weiner:We: License No. 074107

Enclosed please find Commissioner’s Order No. 10958. This Order and any penaltycontained therein goes into effect fve (5) days after the date of this letter.

If the penalty imposed by

N.Y. Genesee Street

Syracuse, West 3520

Profwiorial CenterN. Weiner, Physician

(ictober 31, 1990

Ira

f00~65802VOW DI5CIPLlNE

ONE PARK AVENUE. NEW YORK. NEW PROFESSiONAL OFFCE OF

:223Y YORK/A?BANy N Q\rv’ OF STATE --HE (I$ ‘:\~~\JERS:TY 1 - T 231t-k DEPARTMENT/ THE STATE EDUCATION

WRINRR

CALENDAR NO. 10958

COHMITTEE

IRAN.

RRVIRW TRE

REGENTS OP BEFORT

was guilty of the thirty-first through sixty-second

IIBII . On March 6, 1990, the hearing committee found and concluded

that respondent

'vA1@. The charges were amended

to conform the charges to the proof.

Between June 7, 1989 and August 24, 1989 a hearing was held

in three sessions before a hearing committee of the State Board for

Professional Medical Conduct. The hearing committee rendered a

report of its findings, conclusions, and recommendation, a copy of

which, is annexed hereto, made a part hereof, and marked as Exhibit

IRA N. WEINER, hereinafter referred to as respondent,

licensed to practice as a physician in the State of New York by

New York State Education Department.

was

the

The instant disciplinary proceeding was properly commenced.

A copy of the amended statement of charges is annexed hereto, made

a part hereof, and marked as Exhibit

NQ- 10958

REPORT OF THE REGENTS REVIEW COMMITTEE

Procdeding

against

IRAN. WEINER

who is currently licensed to practiceas a physician in the State of New York.

IN THE MATTER

of the

Disciplinary

-2-

'@a period of

probation". In his April 4, 1990 proposed recommendations,

of. Health, was that

respondent's license to practice as a physician in the State of New

York be revoked.

Respondent's recommendation as to the measure of discipline

to be imposed, should respondent be found guilty, was

Bettan, Esq. Kevin C. Roe, Esq. presented'

oral argument on behalf of the Department of Health.

We have considered the record in this matter as transferred

by the Commissioner of Health.

Petitioner's recommendation as to the measure of discipline

to be imposed, should respondent be found guilty, which is the same

as the recommendation of the Commissioner

10, 1990, respondent appeared before us and was

represented by Jeffrey

llC".

On August

COPY

of the recommendation of the Commissioner of Health is annexed

hereto, made a part hereof, and marked as Exhibit

NNINRR (10958)

specifications, and not guilty of the remaining specifications and

charges, and recommended that respondent's license to practice

a physician in the State of New York be revoked.

On April 26, 1990, the Commissioner of Health recommended

as

to

the Board of Regents that the findings, conclusions, and

recommendation of the hearing committee be accepted in full. We

note that the record shows the date for the transmission of the

file to the Commissioner of Health to be April 27, 1990. A

IRA N.

-3-

l~postponementl~ until the

Court issues its determination in the Article 78 proceeding. We

denied respondent’s application and proceeded without further

delay.

We agree with the hearing committee that respondent is guilty

of gross incompetence, incompetence on more than one occasion, and

negligence on more than one occasion. These charges pertain to

numerous occasions involving 30 patients over a period of years as

shown in the report of the hearing committee. The hearing

committee found respondent's long-standing pattern of practice to

be based on "woefully inadequate knowledge". Respondent dispensed

medications without medical indication. He also dispensed

NRINRR (10958)

respondent's attorney indicated that monitoring would be acceptable

as part of the probation.

The scheduled meeting of the Regents Review Committee in this

matter was adjourned, at the request of respondent's attorney, both

on June 27, 1990 and July 10, 1990. On July 25, 1990, respondent's

attorney sought the issuance by the Supreme Court of a temporary

restraining order staying, enjoining, and restraining any further

disciplinary proceeding in this matter. In signing the Order to

Show Cause in the Article 78 proceeding, the Supreme Court struck

that requested restraining order from the Order to Show Cause and,

therefore, did not grant such relief. Accordingly, our meeting in

this matter was not stayed, enjoined, or restrained. Nevertheless,

respondent’s attorney applied to us for a

IRA N.

-I-

8VunderstoodVl that the records

showed that diet patients were receiving thyroid medications and

diet pills. He was able to synthesize the hospital records,

30 patients

reviewed by petitioner's expert. At the time petitioner's expert

conducted his review regarding various patients, he was aware that

he could not decipher the symbols respondent used in his records.

Nevertheless, petitioner's expert

'Ia vital proponent necessary

to properly analyze the records of the patients in question. We

disagree.

Petitioner's expert was aware of the medications respondent

dispensed to one patient. The pattern of respondent's practices

regarding these dangerous medications was common to all

’

records, information about the medications respondent prescribed

for weight reduction and that such lack of knowledge prevented'

petitioner's expert from possessing

NEINER (10958)

medications in combination despite contraindications for such

combinations and, in the cases of Patients B, P, T, BB, and DD,

despite other medical conditions. Further, for all 30 patients,

respondent failed to perform an adequate physical examination and

appropriate laboratory profiles; failed to perform or order thyroid

function tests prior to dispensing thyroid extract and during the

course of treatment: and failed to provide appropriate dietary

counseling.

Respondent's attorney contended that petitioner's expert did

not know, at the time he conducted his review of respondent's

IRA N.

-5-

2.

on only one occasion. Therefore, we

not guilty of the charges concerning

such charge applies to Patients A, M,

With respect to the charges in paragraph E, respondent

contends that there was no evidence connecting the treatment

Patient AA received

hearing committee's

with the medical history she displayed. The

finding of fact 44, that the use of thyroid

2, the hearing committee's findings show phentermine was

dispensed to these patients

conclude that respondent is

paragraph B.6. to the extent

and

IRA N. WEINER (10958)

autopsy records, and charts he was asked to review. Petitioner's

expert testified that he could render an opinion on the issues at

stake without the necessity of knowing the strengths and dosages

of the medications that were dispensed. Such information was not

necessarily significant for being able to render that opinion. In

our unanimous opinion, the appropriateness of the strengths and

dosages used is not relevant to the issues on which petitioner's

expert testified. Accordingly, petitioner's expert possessed

sufficient information and knowledge to properly analyze the

records of the patients in question.

With respect to the charge in paragraph B.6 of the amended

statement of charges involving the dispensing or prescribing of

phentermine for extended periods, the hearing committee found

(finding 40) that the use of phentermine for more than a few weeks

duration is medically unjustified. In the cases of Patients A, M,

and

Inspite

extract for weight control and

-6

of respondent's use of thyroid

reduction for approximately 20

repe,ated dangerous pattern of

professional misconduct, we agree with the hearing committee that

the appropriate measure of discipline to be imposed is the

revocation of respondent's license to practice as a physician in

the State of New York.

@~assurned~~ that the patient was being made metabolically

overactive in regard to the use of thyroid extract. Therefore, we

conclude that respondent is not guilty of the charges concerning

paragraph E.

We find the remaining conclusions of

be adequately supported by the record and

witnesses to testify at the hearing were

on behalf of petitioner.

the hearing committee to

to be correct. The only

respondent and an expert

Based on the seriousness and

’

it was

"one would have to wonder" in regard to the use of phentermine and

that

WEINER (10958)

extract and phentermine is contraindicated in patients with a

psychiatric history, refers to page 46 of the transcript and

Department Exhibit 39 for evidentiary support. However, the

testimony cited does not specifically refer to Patient AA or

connect her treatment with her specific medical history. The

exhibit cited also does not show that respondent's treatment of

Patient AA failed to meet acceptable standards in that these

medications were dispensed or prescribed despite a psychiatric

history. In Exhibit 39, petitioner's expert merely stated

IRA N.

.findings of fact, being in agreement

with the hearing committee, also be accepted;

’

circumstances, mitigate the penalty we recommend. Respondent has

not shown that he substantially modified his practice before the

hearing committee made its recommendation. In any event, as

petitioner maintained, respondent is grossly incompetent in the

area in which he has chosen to practice. Revocation is also

warranted in view of the extent of the negligence respondent has

committed.

We unanimously recommend the following to the Board of

Regents:

1. The findings of fact of the hearing committee be accepted

and therefore the recommendation of the Commissioner of

Health as to those

combination.~~ Such offer does not change the professional

misconduct respondent has committed or, in view of the

WEINER (10958)

years, respondent was grossly incompetent in his knowledge of

thyroid gland functioning and modern diagnostic laboratory

procedures. He was not aware of the contraindications for

medications used on many patients.

We note that respondent claimed in his April 4, 1990

recommendations that, "should the Board of Regents recommend

following the recommendations of the Hearing Committee, respondent

will voluntarily cease to prescribe phentermine and thyroid extract

in

IRA N.

-8-

fifty-

seventh, sixty-first, and sixty-second specifications

insofar as they relate to paragraph E not be accepted:


Health as to those conclusions, being in agreement with

the hearing committee, be accepted to the extent we

accept the conclusions of the hearing committee:

3. Respondent is guilty, by a preponderance of the evidence,

of the thirty-second through forty-second, forty-fourth

through fifty-fifth, and fifty-eighth through sixtieth

specifications, guilty of the thirty-first, forty-third,

fifty-sixth, fifty-seventh, sixty-first and sixty-second

specifications, except to the extent such specifications

relate to paragraphs B.6. and E, and not guilty of the

remaining specifications and charges:

4. The measure of discipline recommended by the hearing

committee be accepted and therefore the recommendation

of the Commissioner of Health, being in agreement with

the hearing committee, also be accepted and respondent's

license to practice as a physician in the State of New

WEINER (10958)

2. The conclusions of the hearing committee be accepted,

except the conclusions of the hearing committee as to the

thirty-first, forty-third, fifty-sixth, sixty-first, and

sixty-second specifications insofar as they relate to

paragraph B.6. of the charges and as to the

IRA N.

\

Chairperson

(10958)

York be revoked upon each specification of the charges

of which we recommend respondent be found guilty, as

aforesaid.

Respectfully submitted,

JORGE L. BATISTA

HERBERT BERNETTE EVANS

GEORGE POSTEL

Dated:

WEINER IRA N.

01,'22,'8802/09/'8832/10,'88

06/25/'83

To

10,'1.5,'8201/11/88

Fr'cJm

i:R

3. Patient

offi.ce:

Patient

1. Patient A2. Patient

’ and reduction at his

11er.et.o) for weight controlA at%ached Appendix

foLl.owing patients (Patients

are identified in

13213.

A. Respondent treated the

Yorklie-i. SyracxISe, St.reet, C,sne~ee

,

1.988 at 3520 West

1 ? Cecsmher- .through 19i?c;,T3!>11ary 1,

tment to practice

medicine for the period

Depx, Edllcation

Rc!spc;lldent is currently registered

with the New York State

Eclucaticn Department. The

,07410‘,' by the. New York State

10, 1353 by the

issuance of license number

,

practice medicine in New York State on August

____________________----- X

IN THE MATTER AMENDED

OF STATEMENT OF

IRA N. WEINER, D.O. CHARGES

IRA N. WEINER, D.O., the Respondent, was authorized to

____________________--

PROF;SSIONAL MEDICAL CONDUCTSTATE OF NEW YORK DEPARTMENT OF HEALTHSTATE BOARD FOR

examin&tion.

Respondent failed to perform or orderappropriate laboratory profiles.

Respondent failed to perform or orderthyroid function tests prior to thedispensing of thyroid extract.

Respondent failed to perform or orderperiodic thyroid function tests duringthe course of treatment.

Respondent dispensed or prescribedthyroid extract without medicalindication.

Page 2

faiLed

to meet acceptable medical standards in that;:

1.

2.

3.

4.

5.

Respondent failed to perform an adequatephysical

DD

09/09/88

B. Respondent's treatment of Patients A through

07/08/8608/27/87

Patient DD07/06/87

09/02/87Patient CC

10/19/8209/18/87

Patient BB06/'26/87

01/16/88Patient AA

10/25/872.

Patient 02/03/88 03/10/8702/09/88

Patient Y03/03/87

02/09/88Patient X

04/06/8401/25/88

Patient W04/17/87

01/26/88Patient V

07/21/8602/09/88

Patient U11/18/86

02/03/88Patient T

10/25/8502/03/88

Patient S03/05/86

01/29/88Patient R

09/30/8001/26/88

Patient Q12/01/78

01/26/88Patient P

10/26/8402/09/88

Patient 005/02/83

02/12/88Patient N

08/26/8702/03/88

Patient M01/29/85

02/10/88Patient L

05/15/8201,'26/88

Patient K09/03/86

01/26/88Patient J

11/16/8402/02/88

Patient I01/18/80

02/09/88Patient H

08/03/8302/02/88

Patient G06/11/85

01/25/88Patient F

03/04/8702/21/88

Patient E05/07/85

! 5.6.7.8.9.

10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.28.29.30.

Patient D4.i

-L

. Respondent's treatment of Patient AA failed to meet

acceptable medical standards in that Respondent dispensed or

prescribed thyroid extract and phentermine desipte a psychiatric

history.

SPECIFICATIONS

FIRST THROUGH THIRTIETH SPECIFICATIONS

Page 3

,

phenter-mine despite a history of

mitral valve prolapse.

F

I 8.

Respondent dispensed or prescribedphentermine for extended periods of timewithout medical indication.

Respondent dispensed or prescribedthyroid extract and phentermine togetherdespite contraindication.

Respondent failed to provide appropriatedietary counseling.

C. Respondent's treatment of Patients B, P, T and BB failed

to meet acceptable medical standards in that Respondent dispensed

'or prescribed thyroid extract and Phentermine despite

hypertension.

D. Respondent's treatment of Patient DD failed to meet

acceptable medical standards in that Respondent dispensed or

prescribed thyroid extract and

6.

7.

25:The facts in paragraphs A.25 and B.l through B.8.

Page 4

B-1 through B.8.

13. The facts in paragraphs A.13 and B.l through B.8.

14. The facts in paragraphs A.14 and B.l through R.8.


16. The facts in paragraphs A.16, B.l through B.8 and C.






22. The facts in paragraphs A.22 and 8.1 through 8.8.

23. The facts in paragraphs A.23 and 8.1 through B.8.


and s A.12

’


12. The facts in paragraph

B-1 through B.8.



through-B-8.

in paragraphs A.7 and B.l through B.8.

C.

8. The facts in paragraphs A.8 and

A-2, B.l through B.8 and




in paragraphs A.6 and B.l

1985),

'in that, Petitioner

1. The facts

2. The facts

3. The facts

4. The facts

5. The facts

6. The facts

7. The facts

charges:


in paragraphs

(McKinney §6509 (2) Educ. Law 'I gross negligence under N.Y. I The Respondent is charged with practicing the profession with

B-8.


Page 5

throllgh B.8.

in paragraphs A.6 and B.l through b.8.


in paragraphs A.8 and B.l through 13.8.

in paragraphs A.9 and B.l through B.S.


in paragraphs A.11 and B.l through 8.8.




45. The facts in paragraphs A.15 and B.l through

?nd B.l

2nd B.l through R.8.

in paragraphs A.5

7nd B.l through B.8.

in paragraphs A.4

RI1 through B.8 and C.

in paragraphs A.3

(McKinney 1985) in that, Petitioner

charges:

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

The facts

The facts

The facts

The facts

The facts

The facts

The facts

The facts

The facts

The facts

The facts

The facts


in paragraphs A.2,

§6509(2) Educ. Law

misconduot by

practicing the profession with gross incompetence under ,

N.Y.

~.8 and E,



30. The facts in paragraphs A.30, B.l through B.8 and D.

THIRTY-FIRST THROUGH SIXTIETH SPECIFICATIONS

Respondent is charged with professional

~.8.

27. The facts in paragraphs A.27, B.l through

/ 26. The facts in paragraphs A.26 and B.l through

(McKinney 1985) in that,

Petitioner charges that the Respondent committed two or more of

the following:

61. Petitioner repeats and realleges the facts inSpecifications One through Thirty each as an instanceof negligence.

SIXTY-SECOND SPECIFICATION

Page 6

§6509(2) Educ. Law

.~______

Respondent is charged with professional misconduct by reason

of practicing the profession with negligence on more than one

occasion under N.Y.

SPECIF!CATION

A.30, B.l through B.8 and D.

SIXTY-FIRST

'

60. The facts in paragraphs

B.1 through B.8 and 8.



A-27,

B-1 through B.8.



57. The facts in paragraphs

~.8.







54. The facts in paragraphs A.24 and

B-1 through 47. The facts in paragraphs A.17 and

I*

Conduc+:

Page 7

?rofessional Medical

j that Respondent committed two or more of the following:

62. Petitioner repeats and realleges the facts underSpecifications Thirty-one through Sixty each as aninstance of incompetence.

PETER D. VAN BURENDeputy CounselBureau of

§6509(2) in that, Petitioner chargesEduc. Law j occasion under N.Y.

Respondent is charged with professional misconduct by reason

of practicing the profession with incompetence on more than one

Starch, Esq., served as the

Administrative Officer for the Hearing Committee. Michael P.

McDermott, Esq. and Jonathan M. Brandes, Esq. served as

substitute Administrative Officers.

After consideration of the entire record, the Hearing

Committee submits this report.

23C(lO)(e) of the

Public Health Law. Larry G.

of the Public Health law, served as the Hearing

Committee in this matter pursuant to Section

230(l)

‘fcrk pursuant to

Section

Condllct, appointed by the

Commissioner of Health of the State of New

designat.=d members of the

State Board for Professional Medical

I

GEORGE F. COUPERTHWAIT (Chair), MARTIN DIAMOND, D.O.

and DANIEL A. SHERBER, M.D., duly

1

: REPORT OFIN THE MATTER

THE HEARINGOF

COMMITTEEIRA N. WEINER, D.O.

TO: The Honorable David Axelrod, M.D.Commissioner of Health, State of New York

: DEPARTMENT OF HEALTHSTATE BOARD FOR PROFESSIONAL CONDUCTSTATE OF NEW YORK

- South MallEmpire State PlazaAlbany, New York

August 24, 1989Corning Tower BuildingRoom 1432Empire State PlazaAlbany, New York

April 26, 1989(Granted on April 18,1989; Respondent's Counselrecently retained)

October 4, 1989

October 4, 1989

October 11, 1989

Page 2

Cancourse Meeting Room 5

SUMMARY OF PROCEEDINGS

Date of Service of Notice ofHearing and Statement ofCharges against Respondent:

Date of Receipt of AmendedStatement of Charges:

Answer to Statement of Charges:

Pre Hearing Conference:

Dates and Places of Hearings:

Adjournments:

Received Petitioner's ProposedFindings of Fact andConclusions of Law:

Received Respondent's ProposedFindings of Fact andConclusions of Law:

Final Deliberations:

March 24, 1989

September 28, 1989

None

June 7, 1989

June 7, 198999 Washington AvenueAlbany, New York

July 5, 1989

FACE

The following Findings of Fact were made after a

review of the entire record in this matter. Numbers in

parentheses refer to transcript page numbers or exhibits. These

citations represent evidence found persuasive by the Hearing

Committee in arriving at a particular finding. Conflicting

Page 3

Bettan, Esq.P.O. Box 125229 Post AvenueWestbury, New York 11590

Witnesses for Departmentof Health: Theodore H. Zeltner, M.D.

Witnesses for Respondent: Ira N. Wiener, D.O.

STATEMENT OF CASE

The Department's charges allege, in substance, that

Respondent practiced medicine with gross negligence and

incompetence, as well as negligence and incompetence on more

than one occasion, with respect to thirty patients treated by

Respondent for weight control and reduction.

FINDINGS OF

Department of Healthapproved by: Kevin C. Roe, Esq.

Associate Counsel

Respondent appeared by: Jeffrey

l/2 year course of treatment. No physical examination was

recorded except for blood pressures, pulse, weight and body

measurements. Patient B's blood pressure was consistently

elevated during the course of treatment, ranging from mild to

moderate hypertension. No laboratory profiles were obtained and

no thyroid function tests were done. (52-53; Dept. Ex. 3, Dept.

Ex. 5)

Page 4

:10 thyroid function tests

were done. (Dept. Ex. 3, Dept. Ex. 4)

3. Patient B was treated from October 15, 1982 until

February 9, 1988. Respondent dispensed phentermine and thyroid

extract in combination to Patient B continuously throughout the

5

,

thyroid extract in combination to Patient A at the initial

office visit. No physical examination was recorded other than

blood pressure, pulse, weight and body measurements. No

laboratory profiles were obtained and

-11, 1988

and January 25, 1988. Respondent dispensed phentermine and

Genesee Street,

Syracuse, New York. (26, 261)

2. Respondent treated Patient A on January

evidence, if any, was considered and rejected in favor of the

cited evidence.

1. Respondent treated Patients A-DD for weight control

and reduction at his office located at 3520 West

examination.was

recorded except for blood pressure, pulse, weight and body

measurements. No laboratory profiles were obtained and no

thyroid function tests were done. (Dept. Ex. 3, Dept. Ex. 6)

5. Respondent treated Patient D from May 7, 1985 to

February 21, 1988. Respondent dispensed thyroid extract and

phentermine in combination to Patient D for one month in 1985

and three continuous months in 1986. No physical examination

was performed except for blood pressure, pulse, weight and body



6. Respondent treated Patient E from March 4, 1987 to

January 25, 1988. Respondent dispensed thyroid extract and

phentermine in combination to Patient E continuously for six

Page 5

7,..1986, August 1, 1986, August

29, 1986, October 3, 1986, October 28, 1986, November 25, 1986,

February 27, 1987, March 27, 1987, April 24, 1987, May 20, 1987,

July 15, 1987 and August 14, 1987. No physical

4. Respondent treated Patient C from June 25, 1983

to January 22, 1988. Respondent dispensed thyroid extract and

phentermine in combination to Patient C on June 25, 1983, May

15, 1985, June 12, 1985, July 17, 1985, September 11, 1985,

October 11, 1985, November 6, 1985, December 7, 1985, January

4, 1986, January 31, 1986, March

l/2 years of treatment. No physical examination

performed except for blood pressure, pulse, weight and body


was


8. Respondent treated Patient G from August 3, 1983

to February 9, 1988. Respondent dispensed thyroid extract and

phentermine in combination to patient G continuously for two

months in 1983, eight months in 1984, three months in 1985,

eight months in 1987 and four months at the end of 1987 and

beginning of 1988. No physical examination was recorded except

for blood pressure, pulse, weight and body measurements. No

laboratory profiles were obtained and no thyroid function tests


9. Respondent treated Patient H from January 18, 1980


Page 6

months in 1987. No physical examination was performed except




7. Respondent treated Patient F from June 11, 1985 to


phentermine in combination to Patient F continuously throughout

the first 2

16,

examination was recorded except for blood pressure, pulse,

weight and body measurements. No laboratory profiles were

obtained and no thyroid function tests were done. (Dept. Ex. 3,

Dept. Ex. 12)

11. Respondent treated Patient J from September 3,

1986 to January 26, 1988. Respondent dispensed thyroid extract

and phentermine in combination to Patient J continuously for two

months in 1986 and eight months in 1987. No physical


weight and body measurements. No laboratory profiles were

Page 7

Patient I on November

1984, March 22, 1985 and April 19, 1985. No physical

extract

in combination to

1988. No physical examination was recorded except for blood

pressure, pulse, weight and body measurements. No laboratory

profiles were obtained and no thyroid function tests were done.

(Dept. Ex. 3, Dept. Ex. 11)

10. Respondent treated Patient I from November 16,

1984 to January 26, 1988. Respondent dispensed thyroid

and phentermine

phentermine in combination to Patient H at the initial office

visit and continuously for nine months in 1985, twelve months

in 1986 and five months at the end of 1987 and the beginning of

pr-ensure,

pulse, weight and body measurements. No laboratory profiles

were obtained and no thyroid function tests were done. (Dept.

Ex. 3, Dept. Ex. 15)

14. Respondent treated Patient M from August 26, 1987


phentermine in combination to Patient M on August 26, 1987. N O

physical examination was recorded except for blood pressure,

Page 8

blood except for

L continuously for 10

months in 1985 and 1986, and four months in 1986 and 1987. No

physical examination was recorded

Patie!!t. L from January 29, 1985


phentermine in combination to Patient

obtained and no thyroid function tests were done. (Dept. Ex. 3,

Dept. Ex. 13)

12. Respondent treated Patient K from May 15, 1982 to


phentermine in combination to Patient K continuously for four

months in 1982, six months in 1983, two months in 1984 and three

months in 1987. No physical examination was recorded except for




13. Respondent treated

?lo laboratory profiles




to January 26, 1988. Respondent

Patient 0 from October 26, 1984

dispensed thyroid extract and

phentermine in combination to Patient 0 on October 26, 1984,

November 23, 1984, December 21, 1984, January 25, 1985, March

11, 1985, April 19, 1985, May 17, 1985, June 14, 1985, July 19,

1985, February 28, 1986, March 28, 1986, April 25, 1986, May 23,

1986, June 26, 1986, August 19, 1986, September 16, 1986 and

November 18, 1986. No physical examination was recorded except


Page 9

N on May 2, 1983,

September 10, 1985, October 8, 1985, November 5, 1985, January

29, 1986, October 17, 1986, March 17, 1987 and February 9, 1988.

No physical examination was recorded except for blood pressure,

pulse, weight and body measurements.




15. Respondent treated Patient N from May 2, 1983 to



blood pressure, pulse,

weight and body measurements. Patient P's blood pressure was

elevated throughout the course of treatment, ranging from mild

to moderate hypertension. No laboratory profiles were obtained

and no thyroid function tests were done. (54; Dept. Ex. 3, Dept.

Ex. 19)

18. Respondent treated Patient Q from September 23,

1980 to January 1, 1988. Respondent dispensed thyroid extract

and phentermine in combination to Patient Q on September 23,

1980, October 21, 1980, November 19, 1980, December 11, 1980,

January 14, 1981, February 11, 1981, March 18, 1981, April 15,

Page 10

,

January 15, 1985, February 12, 1985, September 23, 1985, October

1, 1985, October 29, 1985, December 10, 1985, January 28, 1986,

June 17, 1986, August 12, 1986, September 15, 1986, December 2,

1986, January 6, 1987 and February 10, 1987. No physical

examination was recorded except for

1984: May 18,

1984, June 16, 1984, August 14, 1984, September 26, 1984,

laboratory profiles were

were done. (Dept. Ex. 3,

17. Respondent

obtained and no thyroid function tests

Dept. Ex. 18)

treated Patient P from December 1, 1978


phentermine in combination to Patient P on December 1, 1978,

December 29, 1978, February 17, 1981, April 20,

? on March 5, 1986, April

2, 1986, November 18, 1986, June 19, 1987, August 21,

1987 and February 3, 1988. No physical examination was




20. Respondent treated Patient S from October 25, 1985


phentermine in combination to Patient S on October 25, 1985,

November 25, 1985 and January 4, 1986. No physical examination

was recorded except for blood pressure, pulse, weight, and body

Page 11

’


19. Respondent treated Patient R from March 5, 1986



1981, May 13, 1981, January 11, 1983, February 8, 1983, March

8, 1983, April 5, 1983, May 3, 1983, May 31, 1983, June 28, 1983,

July 26, 1983, May 22, 1987, June 19, 1987, July 17, 1987, August

14, 1987, September 11, 1987, October 9, 1987, December 4, 1987,

December 23, 1987 and January 29, 1988. No physical examination

was recorded except for blood pressure, pulse; weight and body


laborato?-y profiles were obtained

and no thyroid function tests were done. (56; Dept. Ex. 3, Dept.

Ex. 23)

22. Respondent treated Patient U from July 21, 1986


phentermine in combination to Patient U on July 21, 1986, August

18, 1986, August 11, 1987 and September 8, 1987. No physical

examination was

weight and body

obtained and no

Dept. Ex. 24)

recorded except for blood pressure, pulse,

measurements. No laboratory profiles were

thyroid function tests were done. (Dept. Ex. 3,

Page 12

l-0, 1987,

March 10, 1987, April 7, 1987, May 5, 1987, June 2, 1987, June

30, 1987, July 28, 1987 and August 25, 1987. No physical


weight and body measurements. Patient T's blood pressure was

elevated throughout the course of treatment, ranging from mild

to moderate hypertension. No



21. Respondent treated Patient T from November 18,

1986 to February 9, 1988. Respondent dispensed thyroid extract

and phentermine in combination to Patient T on November 18,

1986, December 16, 1986, January 13, 1987, February

AprlL 6, 1984, May

examination was

weight and body

obtained and no


25. Respondent treated Patient from March 3, 1987 to


phentermine in combination to Patient X on March 3, 1987, March

31, 1987, April 28, 1987, May 26, 1987, June 23, 1987, July 28,

1987, August 25, 1987, September 22, 1987, November 17, 1987,

Page 13

W on

4, 1984 and February 9, 1988. No physical

recorded except for blood pressure, pulse,

measurements. No laboratory profiles were

from April 6, 1984

thyroid extract and

Patient-W

to February 9, 1988. Respondent dispensed


10; 1987. No






23. Respondent treated Patient V from April 17, 1987


phentermine in combination to Patient V on April 17, 1987 to

January 25, 1988. Respondent dispensed thyroid extract and

phentermine in combination to Patient V on April 17, 1987, May

15, 1987, June 15, 1987, July 13, 1987 and August

Resp0nden.t dispensed thyroid extract and

phentermine in combination to Patient Z on January 16, 1988.

No physical examination was recorded except for blood pressure,




28. Respondent treated Patient AA from June 26, 1987

to September 18, 1987. Respondent dispensed thyroid extract and

Page 14

16, 1988.

?Jo laboratory profiles

were obtained and no thyroid function test were done. (Dept.

EX. 3, Dept. Ex. 28)

27. Respondent treated Patient Z from October 25, 1987

to January

December 15, 1987, January 12, 1988 and February 9, 1988. No





26. Respondent treated Patient Y from March 10, 1987


phentermine in combination to Patient Y on March 10, 1987, April

8, 1987, May 6, 1987, August 21, 1987 and February 3, 1988. . No


pulse, weight and body measurements.

BB's

Page 15

14, 1987, May 12, 1987, June 8, 1987, July 8, 1987 and August

5, 1987. No physical examination was recorded except for blood

pressure, pulse, weight and body measurements. Patient

IQ, 1983, August 15, 1984, September 12, 1384, October

8, 1984, November 7, 1984, December 5, 1984, January 1, 1985,

January 30, 1985, April 12, 1985, May 10, 1985, June 7, 1985,

June 28, 1985, July 2, 1985, November 24, 1986, December 19,

1986, January 20, 1987, February 17, 1987, March 17, 1987, April

Hutchings

Psychiatric Center with a diagnosis of NOS psychotic disorder;

rule out drug/diet pill induced psychosis; rule out catatonic

schizophrenia. (Dept. Ex. 31)

30. Respondent treated Patient BB from October 19,

1982 to September 2, 1987. Respondent dispensed thyroid extract

and phentermine in combination to Patient BB on October 19,

1982, May

I

treatment by Respondent, Patient AA was admitted to

phentermine in combination to Patient AA on June 26, 1987, July

24, 1987 and August 21, 1987. No physical examination was




29. Patient AA had a history of psychiatric illness,

including two previous hospital admissions. During her

DD on July 8, 1986, August

6, 1986, August 28, 1986, October 24, 1986, November 21, 1986,

February 26, 1988, July 13, 1988, August 12, 1988 and September

9, 1988. No physical examination was recorded except for blood

pressure, pulse, weight and body measurements. No laboratory

profiles were obtained and no thyroid function tests were done.

(Dept. Ex. 3, Dept. Ex. 36, Dept. Ex. 3'7)

33. On October 4, 1986, Patient DD was seen at the

emergency room at Crouse-Irving Memorial Hospital, Syracuse, New

Page 16

Patj.ent DD from July 8, 1986

to September 9, 1988. Respondent dispensed thyroid extract and

phentet-mine in combination to Patient

’


no thyroid function tests


*

laboratory profiles were obtained and

and,

August 3, 1987. No physical examination was recorded except for


blood pressure was elevated during the course of treatment,

ranging from mild to moderate to severe hypertension. No


were done. (56; (Dept. Ex. 3, Dept. Ex. 32)

31. Respondent treated Patient CC from July 6, 1987

to August 27, 1987. Respondent dispensed thyroid extract and

phentermine in combination to Patient CC on July 6, 1987

prcposed treatment plan

includes stimulant medication, electrocardiography and

urinalysis are also necessary. These diagnostic studies are

necessary to detect medical conditions that a patient may have

Page 17

dye, ears, nose and throat. In some cases

it should include rectal, prostate and neurological

examinations. (28-31; Dept. Ex. 39)

36. Dr. Zeltner further testified that prior to

beginning a weight reduction program, laboratory profiles,

including complete blood counts and blood chemistries are

indicated. Additionally, where the

expert witness

for the department. (14)

35. It was Dr. Zeltner's opinion that a basic physical

examination, including a review of all major organ systems for

signs of any other concomitant illness, is required prior to

beginning a weight reduction program. This would include vital

signs, examination of the lungs, heart, abdomen, extremities,

skin, lymph nodes,

DD's condition was related

to Respondent's treatment. (63; Dept. Ex. 38, Dept. Ex. 40)

34. Theodore H. Zeltner, M.D., a board certified

physician in internal medicine, testified as an

PAC's which later cleared. Patient

York complaining of palpitations, nausea, diaphoresis and

syncope. Her EKG in the emergency room was irregular, showing

treatF,ent with thyroid extract

periodic testing of thyroid function is necessary to prevent the

initiation of hyperthyroidism in the patient. (42-43; Dept. Ex.

39)

39. The medical indications for the use of thyroid

extract are to correct an underactive thyroid gland or to

suppress an enlarged gland. Thyroid extract is not medically

indicated for weight reduction. (39, 43-44, 148-149; Dept. Ex.

39)

40. Phentermine is an amphetamine-like derivative used

as an appetite suppressant on a short-term basis in conjunction

with a calorie restricted diet. The appetite suppressant effect

Page 18

theI

thyroid gland is producing an appropriate level of thyroid

hormone, or is suffering from any abnormalities. (38-43; Dept.

Ex. 39)

38. During a course of

,j

function tests are necessary to determine whether or not

which would contraindicate the use of certain medications or

diet programs. Further, it is necessary to determine whether

any weight loss experienced by a patient is due to the diet

program, or an underlying medical condition. (36-38; Dept. Ex.

39)

37. Prior to dispensing thyroid extract, thyroid

of phentermine wears off after a few weeks. However, its

potential side effects, i.e., increased blood pressure,

palpitations, chest pain, insomnia and emotional disturbances,

remain constant. The use of phentermine for more than a few

weeks duration is medically unjustified. (45-46; Dept. Ex. 39)

41. Thyroid extract and phentermine in combination are

contraindicated. The combination of the two magnifies the risk

of potential side effects with no potential benefit to the

patient. (47, 133, 192-193; Dept. Ex. 39)

42. The use of thyroid extract and phentermine in

patients with hypertension is contraindicated by the risk of

exacerbating this condition. (52-53; 192-193, 201; Dept. Ex. 39)


patients with mitral valve prolapse is contraindicated by the

risk of exacerbating this condition. (60-61, 171; Dept. Ex. 39)


patients with a psychiatric history is contraindicated by the

risk of emotional disturbance. (46; Dept. Ex. 39)

45. During the course of weight control and reduction

appropriate dietary counseling, including a calorie restricted

diet, is necessary. (48-50)

Page 19

counselling

to his patients in the form of written instructions. (Resp. Ex.

A)

CONCLUSIONS

The following conclusions were made pursuant to the

Findings of Fact listed above. All conclusions resulted from a

unanimous vote of the Hearing Committee unless noted otherwise.

Numbers in parentheses refer to the specific Findings of Fact

which support each conclusion.

The Hearing Committee concludes that the following

Specifications should be SUSTAINED:

1. Thirty-One through Sixty: (l-44);

2. Sixty-One: (l-44);

3. Sixty-Two: (l-44).

The Hearing Committee concludes that the following

Specifications should NOT BE SUSTAINED:

1. One through Thirty: (l-44).

Page 20

46. Respondent provides minimal dietary

incomnetence is an unmitigated lack of skill

or knowledge necessary to perform an act undertaken by the

licensee in the practice of medicine;

Page 21

6509(2). (The Education

Law does not provide definitions). These suggested definitions

are set forth below:

Incompetence is a lack of the skill or knowledge

necessary to practice the profession;

Gross

inter alia, suggested definitions for various types

of misconduct prohibited under Section

i'ork Education Law",

describes,

entlit_led "Definitions of

Professional Misconduct under the New

Millock, Esq., General Counsel

for the Department. This document,

on

more than one occasion. During the course of its deliberations,

the Hearing Committee consulted a memorandum, dated September

19, 1988, prepared by Peter J.

6509(2) of the Education Law by

medicine with gross negligence, gross incompetence,

on more than one occasion, and with incompetence

Respondent is charged with professional misconduct

within the

practicing

negligence

meaning of Section

hn

indifference to the rights of others necessary to sustain the

charge of gross negligence.

Respondent's use of phentermine and thyroid extract

is based on training which he received approximately twenty

years ago, from a private physician in Kansas City. (Tr., pp.

229, 332). Respondent was unable to identify any additional

training regarding the management of obese patients received

Page 22

incompetence on more than

one occasion and gross incompetence. However, the Hearing

Committee was of the unanimous opinion that Respondent's conduct

did not demonstrate the disregard of the consequences and

a-

Utilizing these definitions as a framework for its

deliberations, the Hearing Committee concluded that, by a

preponderance of the evidence, Respondent was guilty of

negligence on more than one occasion,

Nealiaence is a failure to exercise the care that

would be exercised by a reasonably prudent licensee under the

circumstances, and

Gross neuliaence is a failure to exercise the care

that would be exercised by a reasonably prudent licensee under

the circumstances, a disregard of the consequences which may

ensue from such failure and an indifference to the rights of,

others.

T and BB

failed to meet minimally acceptable medical standards, in that

he dispensed thyroid extract and phentermine to these patients

in spite of their contraindicating histories of hypertension.

Further, Respondent's treatment of Patient DD failed to meet

acceptable medical standards in that Respondent dispensed

thyroid extract and phentermine despite a contraindicating

history of mitral valve prolapse. Additionally, Respondent's

treatment of Patient AA failed to meet acceptable medical

Page 23

t.o this unmitigated lack of basic medical

knowledge, Respondent's treatment of Patient's B, P,

n,ot

appear to understand how the thyroid gland functions, nor how

to use any of the modern diagnostic laboratory procedures used

to evaluate its functioning. He couldn't identify the side

effects of phentermine nor the contraindications for its use.

(Tr., pp. 46-47, 326-327, 343).

Due

he'did

*

control and reduction. (Tr., p. 334).

Despite Respondent's use of thyroid extract for weight

control and reduction for approximately twenty years,

wa& unable to

identify any authoritative sources which recommend the use of

thyroid extract to treat obesity, thyroid extract in combination

with phentermine, or the long-term use of phentermine for weight

p. 334). He during the intervening years. (Tr.,

(Tr., PP . 230, 284).

abnormal findings on

claimed that he personally performed a

on each of the thirty patients in question.

He also testified that he would note any

the patient's charts. (Tr., p. 236).

However, it would strain the credulity of the Hearing Committee

to find that none of the thirty randomly chosen patients

presented at the hearing had any abnormal findings upon physical

examination. Therefore, the Hearing Committee discounted

Respondent's testimony and concluded that he failed to perform

physical examinations on Patients A-DD which met minimally

Page 24

qigns and body

measurements.

Respondent

physical examination

#35). It was also

undisputed that the medical records to patients A-DD (records

chosen at random) contain no entries regarding physical

examinations other than partial vital

(See, F.O.F.

.

standards in that Respondent dispensed thyroid extract and

phentermine despite a contraindicating psychiatric history.

Respondent's misconduct was compounded by his failure

to perform adequate patient histories and physical examinations

before embarking on a potentially hazardous course of treatment

for the thirty patients identified in this case. There was no

factual dispute between the parties as to what constitutes an

adequate physical examination.

spectrllm of available penalties,

including suspension, probation, censure and reprimand, or the

imposition of civil penalties of up to $10,000 per violation.

The record clearly demonstrated Respondent's

long-standing pattern of practice, which was based on woefully

inadequate knowledge of the basic physiology of the thyroid

gland, or of the medications which Respondent prescribed for

weight reduction and control. His continued indiscriminate use

of such potentially dangerous drugs as phentermine would place

the community at an unacceptable risk. A mere suspension would

not alleviate this risk. Additionally, given the nature of

Page 25

’

Respondent's license to practice medicine in the State of New

York be revoked. This recommendation was reached after due

consideration of the full

acceptable standards. The Hearing Committee concluded that

Respondent's conduct with regard to Patient's A-DD constituted

gross incompetence, incompetence on more than one occasion, as

well as negligence on more than one occasion, as defined above.

RECOMMENDATIONS

The Hearing Committee, pursuant to its Findings of

Fact and Conclusions herein unanimously recommends that

Thus , it is

penalty, under the

Based upon the foregoing, the Hearing Committee made

the following recommendations:

1. That Specifications One through Thirty, as set

forth in Department's Exhibit #l-A NOT BE SUSTAINED;

2. That Specifications Thirty-One through Sixty-Two

be SUSTAINED, and

Page 26

it.

:.

Respondent's medical practice. (which is entirely office-based)

a term of probation coupled with monitoring would not be

practicable. The imposition of a monetary penalty would also

serve no useful purpose, since it would remove resources for

suitable re-training, should Respondent seek

clear that revocation is the only appropriate

circumstances.

-

.

HWAITF (Chair)

Martin Diamond, D.O.Daniel A. Sherber, M.D.

Page 27

ti&hc/d 6 , New York1990

Respectfully submitted,

3. That Respondent's license to practice medicine in

New York State be REVOKED.

DATED:

of Regents:

A. The Findings of Fact and Conclusions of theCommittee should be accepted in full;

B. The Recommendation of the Committee should beaccepted: and

C. The Board of Regents should issue an orderadopting and incorporating the Findings of Factand Conclusions and further adopting as itsdetermination the Recommendation described above.

I hereby make the following recommendation to the

Board

*

evidence in support of the charges against the Respondent was

presented by Kevin C. Roe, Esq.

NOW, on reading and filing the transcript of the

hearing, the exhibits and other evidence, and the findings,

conclusions and recommendation cf the Committee,

Bettan, Esq. The D.O., appeared by Jeffrey Ira N. Weiner,

1989~ and August 24' 1989. Respondent,5, 1989, July 7,

hel’d

on June

;

TO: Board of RegentsNew York State Education DepartmentState Education BuildingAlbany, New York

A hearing in the above-entitled proceeding was

-_--___-_--__--_--_---~--~~~~~-~~_~-__~~__~

RFCOnnENDATIONIRA N. WEINER, D.O.

1COMMISSIONER’S

OF :

____-_-__-__________~~~~--~--~~~-~~~~-~~~-~ XIN THE MATTER

) STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCTt DEPARTMENT OF HEALTH

I

STATE OF NEW YORK

: transmitted with this Recommendation.

New York

State of New York

Page 2

The entire record of the within proceeding is

OTATE OF NEW YORK

IRAN. WEINER

CALENDAR NO. 10958

COMMIBSIONER OFEDUCATION OF THE

TEE

‘

ORDER OF

-

F

fifty-seventh, sixty-first, and sixty-second specificationsinsofar as they relate to paragraph E not be accepted:and therefore the recommendation of the Commissioner ofHealth as to those conclusions, being in agreement withthe hearing committee, be accepted to the extent weaccept the conclusions of the hearing committee;

.

IN THE MATTER

OF

IRAN. WEINER(Physician)

DUPLICATEORIGINAL

VOTE AND ORDERNO. 10958

Upon the report of the Regents Review Committee, a copy ofwhich is made a part hereof, the record herein, under Calendar No.10958, and in accordance with the provisions of Title VIII of theEducation Law, it was

VOTED (October 19, 1990): That, in the matter of IRA N.WEINER, respondent, the recommendation of the Regents ReviewCommittee be accepted as follows:1. The findings of fact of the hearing committee be accepted


Health as to those findings of fact, being in agreement

with the hearing committee, also be accepted:2. The conclusions of the hearing committee be accepted,

except the conclusions of the hearing committee as to thethirty-first, forty-third, fifty-sixth, sixty-first, andsixty-second specifications insofar as they relate to

paragraph B.6. of the charges and as to the

,/J$390.

Commissioner of Education

c:i:,+& cl_ ad-"'day of

e-d that the Commissioner of Education be empowered to execute,for and on behalf of the Board of Regents, all orders necessary to

carry out the terms of this vote;and it is

ORDERED: That, pursuant to the above vote of the Board of

Regents, said vote and the provisions thereof are hereby adoptedand SO ORDERED, and it is further

ORDERED that this order shall take effect as of the date ofthe personal service of this order upon the respondent or five daysafter mailing by certified mail.

IN WITNESS WHEREOF, I, Thomas Sobol,

Commissioner of Education of the State ofNew York, for and on behalf of the StateEducation Department and the Board ofRegents, do hereunto set my hand and affixthe seal of the State Education Department,at the City of Albany, this

(rooss)

3. Respondent is guilty, by a preponderance of the evidence,

of the thirty-second through forty-second, forty-fourth

through fifty-fifth, and fifty-eighth through sixtieth

specifications, guilty of the thirty-first, forty-third,

fifty-sixth, fifty-seventh, sixty-first and sixty-second

specifications, except to the extent such specifications

relate to paragraphs B.6. and E, and not guilty of theremaining specifications and charges; and

4. The measure of discipline recommended by the hearingcommittee be accepted and therefore the recommendationof the Commissioner of Health, being in agreement withthe hearing committee, also be accepted and respondent's

license to practice as a physician in the State of NewYork be revoked upon each specification of the chargesof which respondent was found guilty, as aforesaid:

WNZNZRWeIRA

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Transcript of RECEIVED · extract for weight control and-6 of respondent's use of thyroid reduction for...